Do Admitted Patients Held in the Emergency Department Impact the Throughput of Treat-and-release Patients?

Authors


University of Rochester Medical Center, Department of Emergency Medicine, Box 655, 601 Elmwood Avenue, Rochester, NY 14642. Fax: 716–461–9778: e-mail: jbazarian@ed.urmc.rocheste.edu

ABSTRACT

Objective: To examine the impact of reducing ED “boarders” (through the use of a short-stay inpatient medicine unit) on the amount of time that treat-and-release patients spend in the ED.

Methods: A retrospective analysis of hours spent in the ED was made at a university hospital teaching ED for treat-and-release patients in 4 clinical categories: chest pain, asthma exacerbation, sickle-cell crisis, and seizure. The average hours per patient spent in the ED during the 4-month intervals before (August-November 1993) and after (August-November 1994) the establishment of the short-stay medicine unit were compared. Data were analyzed using the 2-tailed, unpaired t-test.

Results: This short-stay inpatient medicine unit received on average 135 patients per month from the ED, with an average length of stay of 2.4 days. The mean (±SD) number of admitted patients per day waiting in the ED >8 hours for an inpatient bed dropped from 9.6 ± 4.2, before the institution of this unit, to 2.3 ± 2.6. There was a significant reduction in the average number of hours spent in the ED by treat-and-release patients with chest pain (from 7.3 ± 6.0 to 5.5 ± 4.8 hr/patient, p c 0.001) and asthma exacerbation (from 5.0 ± 3.6 to 4.2 ± 2.9 hdpatient, p < 0.05), but not with sickle-cell crisis or seizure, after the implementation of the short-stay unit.

Conclusion: Reducing the number of admitted patients waiting in the ED for inpatient beds, in this case by establishment of a short-stay medicine unit, is associated with a decrease in the interval that treat-and-release patients spend in the ED.

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